Document(s) 1 de 14

This book assesses the health care reforms of the past decade in Argentina, Brazil and Mexico. The authors are in agreement that reform in the governance, management and financing of the provision of health services was essential.

However, they criticize the outcomes of the reform process not only for the anticipated exacerbation of social and economic inequalities, but also because of inattention paid to human resources as well as much-needed development of science and technology.

The country studies are set within the political and economic context of the reform period and strive to assess outcomes for people at different levels of income. The methodology illustrates the approach for which IDRC strives in the work it supports. IDRC operates on the belief that no “problem” — in this case accessible, affordable and appropriate health care — can be viewed in isolation from its context. As well, “solutions” must be judged by identifying exactly whose lives have improved.

Sadly, the ultimate conclusion of the researchers is not a hopeful one. The reforms are likely to leave many citizens with inadequate care and pit the middle class against the poor, both culturally and politically. Social solidarity will remain elusive. Indeed, if governments continue their implementation of reforms, the health sector could well be modernized without any reduction in the economic inequities fracturing the region.

This study should be a flashing red light to policymakers and the public: a signal to stop and confirm direction. Through their quality, accessibility and governance, health services demonstrate a democracy’s effectiveness in meeting the critical needs of its citizens, just like education does.

Traditionally, the state in Latin America has been strong in its ability to control its citizens but not in creating the social solidarity (and services) that citizens need. Failure of the new democracies to strengthen the social state could have dire consequences. The reality is that so far, at least in the three countries studied, governments have not kept social fairness as the “bottom line” in the design of health reforms.

This study makes an important contribution to re-thinking policy directions. Its conclusions should inspire politicians and the public to take a second look.

Maureen O’Neil
President
International Development Research Centre  

info@idrc.ca

Document(s) 1 de 14